Emergency Medicine Book

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Scombroid Fish Poisoning

Aka: Scombroid Fish Poisoning, Scombroid Poisoning, Scombroid Toxicity, Scombroid, Histamine Fish Poisoning
  1. Epidemiology
    1. More common in Hawaii and California
  2. Pathophysiology
    1. Improper handling of fish (delay to refrigeration, poorly refrigerated or inadequately frozen)
      1. Scombridae family or dark meat fish such as Tuna, Mahi-mahi,or mackerel
      2. Food typically tastes atypical
    2. Histidine from fish muscle is decarboxylated to histamine by marine Bacteria
      1. Bacteria containing histidine decarboxylase include Escherichia, Klebsiella, Proteus, Vibrio, pseudomonas
    3. Isoniazid potentiates this reaction
  3. Symptoms (Related to histamine release)
    1. Typical histamine related response
      1. Severe Flushing including facial Flushing
      2. Diarrhea
      3. Palpitations
      4. Abdominal Pain
      5. Urticaria
      6. Bronchospasm with Wheezing
      7. Orthostatic Hypotension
    2. Histamine-3 (H3) activity related symptoms
      1. Nausea
      2. Vomiting
      3. Severe Headache
  4. Labs
    1. Avoid histamine level (not useful)
    2. Tryptase level
      1. May differentiate from Allergic Reactions
  5. Differential Diagnosis
    1. Allergic Reaction to Anaphylaxis
  6. Course
    1. Onset within 10-60 min (on average 20-30 min) of ingestion
    2. Resolves within 6-8 hours, up to 24 hours (rarely more)
  7. Management
    1. Avoid Gastric Decontamination in most cases
    2. Antihistamine
      1. Diphenhydramine (Benadryl) 50 mg IV/IM}PO
      2. Consider H2 Receptor Blocker (Ranitidine, Cimetidine)
    3. Nebulized Albuterol
      1. Indicated for bronchospasm
    4. Other symptomatic management
      1. Antiemetics
  8. References
    1. Koch and Tomaszewski (2018) Crit Dec Emerg Med 32(1): 24

Scombroid fish poisoning (C0275143)

Concepts Injury or Poisoning (T037)
ICD10 T61.1
SnomedCT 212866009, 241773001, 83227006
English Scombroid fish caus tox effect, Toxic eff/scombroid fish poisn, scombroid poisoning (diagnosis), scombroid poisoning, scombroid fish poisoning, histamine fish poisoning, Scombroid fish causing toxic effect (event), Scombroid fish causing toxic effect (disorder), Scombroid fish poisoning, Histamine fish poisoning, Scombroid fish causing toxic effect, Toxic effect of scombroid fish poisoning, Scombroid fish poisoning (disorder), poisoning; scombroid fish, scombroid fish; poisoning
German Scombroid-Fischvergiftung
Korean 스콤브로이드 물고기 중독
Dutch scombroïdvis; vergiftiging, vergiftiging; scombroïdvis, Vergiftiging door scombroïdvis
Spanish intoxicación por pescado escombroideo (trastorno), intoxicación por pescado escombroideo
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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